Water Birth Unplugged-Proceedings of the First International Water Birth Conference

Beverley Lawrence Beech (ed)

Books For Midwives, 146pp, 10.99 ISBN 1 898597 53 8

It is so easy to confuse the ideas of "value" and "evaluation" - perhaps never more so
than when talking about water labour and water birth. While nobody would doubt the
value of water in labour and birth, it has yet to be evaluated vigorously. So, just as the
conference from which it sprang was long overdue, this book has long been
necessary.

While other books may concentrate on the subtle romanticism of the medium
beautiful pictures of peaceful babies swimming gently to the surface, satisfied parents
sharing the warmth of the pool - and they are justified in doing so, there is a genuine
need to pool our (no pun intended) information, in order to raise the general level of
awareness of all the issues.

Labour and birth in water, for many women, comprise some of the most happy
memories of their birthing experience. But as labour and birth in water become more
and more a part of the "official" ways of giving birth, practitioners are faced with a real
lack of information on the subject.

The information is out there; some of it on paper, some of it in the experience of

practitioners who've made labour and birth in watertheir speciality. But up until the
Spring of 1995 it wasn't always easy to get at. In editing the proceedings of the First
InternationalWater Birth Conference into this highly readable volume, Beverley Beech
has made a substantial contribution to the process.

Contained in this book is the collected knowledge of well know water birth enthusiasts
such as Michel Odent, Janet Balaskas, Yehudi Gordon and Roger Lichy. But it also
contains the views of other pivotal, though less well known figures. Giving a view
of water birthinternationally, for instance are Athena Vassie (Australia), Petra
Maghella (Italy), Anne Uller (Denmark) and Michael Adam (Austria). Caroline Flint,
Cass Nightingale and Dianne Garland give their views of water birth and the midwife.

The conference, while providing a broad base of information, never lost sight of the
fact that water birth stands for something much larger than statistics and outcomes.
That the water birth movement, like the VBAC movement, is fuelled by women and
practitioners who have accepted that we are "doing birth" wrong in so many ways and
that there is a genuine need to find an approach to birthwhich restores the balance of
power between the woman and her practitioner, which shows respect for the process
of labour andbirth.

With this in mind, some of the most interesting sections in the book for me were those
which explore not simply the mechanics ofwater labour and birth but those which aim
to put it in its context. Part One: Why a Water Birth contains the kind of stirring stuff
you'd expect from the likes of Marsden Wagner, Janet Balaskas and Michel Odent.
Part Three: Water Birth and the Family with talks from Jayn Ingrey of Splashdown
Pools and Roger Lichy is both moving and informative since they feature not only
information, but the personal experiences of the speakers involved. Ingray's
comments on parental rights set against some of the negative comments made to
women by hospital staff are very telling; they range from "The consultant does not
advocate water birth" to, unbelievably "Who's going to pay for the water?"

In the same way, Part Five: Water Birth and the Midwife, with contributions from Cass
Nightingale, Caroline Flint and Dianne Garland has many lessons on many levels for
those practitioners who are interested in making sure the women they look after get
the best possible care on land or in water.

Water Birth came of age at this conference, as this collection clearly shows. Whether
you are interested in water birth from a medical, historical or experiential perspective,
this book will provide plenty of food for thought.

Word count: 664

Copyright Association for Improvement in the Maternity Services Oct 31, 1996

Water birth

The following is a summary of a press release compiled by Jayn Ingrey on Monday

18th October 1993. She states that it was prepared in collaboration with several
midwives and obstetricians who have approved its content.

On Friday 15th October the Press falsely led us to believe that "several British babies
had drowned due to underwater births". These statements were completely untrue.
The following day it was revealed that the two British cases involved water labours,
and the babies were not born underwater. THERE HAS NEVER BEEN ANY
RECORDED CASE OF A BRITISH BABY DROWNING DURING AN
UNDERWATER BIRTH OR SUFFERING ANY ILL-EFFECTS AS A RESULT OF THE
MOTHER USING A BIRTHING POOL.

The controversy arose because a Swedish baby died during a home birth in which
a water birth pool had been used. There is no evidence whatsoever that the baby
drowned or died as a result of the mother using a water birth pool. Home birth is not
allowed in Sweden and it seems there is discrimination against the midwives
involved.

There was similar sensationalism in the Press in September 1990 when a French
baby was reported to have drowned in a water birthpool. However, enquiry revealed
that there was no midwife present (which is against the law in France, as it is in UK),
and the mother had actually left the pool to give birth. The amniotic sac was still intact
and though a midwife would have known what to do, the couple did not, and the baby
died.

The only known deaths that could be associated with underwater births both
happened approximately ten years ago, one in America and one in Australia, where
both babies were held underwater for several minutes after the birth. If babies are
lifted to the surface immediately after birth, as they are in Britain, this is 100% safe.

Women have been taking baths to ease their labour pains long before water
births were introduced, and the World Health Organisation promotes the use of
immersion in warm water as a safer alternative to analgesic and anaesthetic drugs.
The Royal College of Midwives has stated that the use of water birth pools is
completely safe.

So who is worried about their use? Professor Geoffrey Chamberlain, President of the
Royal College of Obstetricians and Gynaecologists (RCOG) believes "bathing in
warm water can help soothe labour pains" but he advises women to get out of the
pool to give birth, (as the two British mothers previously mentioned did).

Jayn Ingrey telephoned the Press Office of the RCOG, who confirmed that the
sensational report of 15th October was instigated by some obstetricians. It would
appear that they have used the Swedish tragedy as an opportunity to place fear of
the use of water birthpools in people's minds. Now why should they want to do this?
Could it be a backlash to the Winterton Report, (March 1992), which proved
statistically that where there is a higher ratio of obstetricians per 1,000 births, there is
a higher caesarean rate and a higher death rate in babies?

The recent report of the Health Minister, ("Changing Childbirth"), recommends that
women should have more choice and more say in their care in childbirth. There has
been a rise in home births as well as a rise in the use of water birth pools since last
year, yet the perinatal mortality rate last year was at an all time low. (Both reports
support the fact that homebirths are a safe option for the majority of women with
normal pregnancies).
IF YOU WOULD LIKE TO LEARN MORE ABOUT USING WATER BIRTH POOLS,
ENB approved Midwives' Study Days will be held in London on Saturdays 12th
February and 16th July 1994. (Contact Splashdown Water Birth Services (founder
Jayn Ingrey) for details, 17 Wellington Terrace, Harrow-on-the-Hill, Middlesex, HA1
3EP, (Tel. 081 423 9308 or 081 422 9308). (Splashdown have hired water birth pools
to over 2000 women, none of whom have had any problems relating to pool use).

Word count: 668

Copyright Association of Radical Midwives Dec 31, 1993

EAST HERTS WATER BIRTH DBACLE

In April 1993 Valerie French and her partner Garry Curran booked a home birth with
a local midwife, Valerie Foster. They wanted their baby to be born in water, so they
hired an inflatable pool.

They were blissfully unaware of any potential problems until December 1993 when
Mrs Yeap, a midwifery supervisor from the Queen Elizabeth II Hospital in Welwyn
Garden City, arranged to visit them. She told them that the midwives were unhappy
about delivering the baby in water. This came as a surprise to the family as no-one
had mentioned any anxieties before. Later conversations with the community
midwives revealed that only one midwife was concerned, and she was not booked to
attend!

Two days later, Valerie French telephoned the hospital and was told that they could
not offer a water birth as they did not have a contract to do so. A letter then arrived
reiterating that there was no contract, and giving the misleading and dishonest
impression that the Trust could give permission (and by implication deny permission)
for a woman to labour, but not give birth, in water.

Fortunately, the couple knew their rights and ignored the letter.

In the meantime the midwives, Valerie Foster and Gill Kurzins, were told of this new
Trust policy. Unfortunately, none of the midwives asked precisely what the Trust
advised if the mother chose to ignore the policy.

On the 16th January 1993 Valerie French gave birth to a daughter, Mollie, in water.
The midwives had been joined by a third midwife, Pain Williams, who had been
required to attend by Freda Kelly, Director of Midwifery. The midwives, during the
labour, told the mother that it was Trust policy that she should get out of the water for
the birth, but she refused. The midwives, feeling that they had compiled with Trust
policy, made no more of it, and helped her to give birth in the water.
The following day Miss Freda Kelly suspended Val Foster and Gill Kurzins from duty.
Ms French was denied care from the women who had looked after her during the
pregnancy and birth and she and her partner, Garry Curran, were very upset indeed
that two trusted and skilled midwives were being penalised for doing an excellent job.

On the 9th February their case was heard by the head of obstetrics at the hospital.
Val Foster was given a final written warning for not calling for assistance when
a water birth, which she was not trained for, became inevitable and required to
undertake three months' supervised practice in the hospital. Gill Kruzins was given a
first written warning for refusing to leave the mother therefore "prejudicing cover in her
own area," and also required to undertake three months' supervised practice. Miss
Kelly had told her that she was not to attend the water birth as she had sent Pam
Williams to do so, but as Gill was off duty, and Valerie French wanted her there, she
chose to stay. No action was taken against Pam Williams, indeed she gave evidence
against the other two!

As the "inevitability" of Valerie French giving birth in the water was not clear until
shortly before she actually did so, no-one has questioned the sense of leaving a
mother at this critical time to make a telephone call -- and who were they going to call
anyway? Would they have arrived in time?

THEY SHOULD PULL OUT THE PLUG!

The Chief Executive Dr Paul Lambden in a subsequent TV interview stated that if the
woman would not get out of the pool the midwives should have pulled out the plug.
Clearly, Paul Lambden's knowledge of portable water pools is exceedingly limited,
they do not have plugs!

Freda Kelly knew that a water birth had been booked, the Trust's information booklet
"Your choice when having a baby" issued in November 1993 and approved by Freda
Kelly, advertised the availability of water births at home, yet she made no attempt to
ensure that her staff were adequately trained to offer this service. Valerie Foster and
Gill Kurzins had already taken action, on their own initiative, to ensure that they were
properly informed and up-to-date on procedures during a water birth.

Letters flew. Dr Lambden, a GP with political aspirations, justified the behaviour of the
Supervisor of Midwives claiming that the hospital was "not prepared to commit the
safety of their patients to a technique which has not yet been fully evaluated."....that
"There is certainly significant evidence to demonstrate that infections, both of the
baby and of the mother, increase if they deliver inwater."...that the midwives had
"breached their own professional code of rules by undertaking a procedure for which
they were not trained and which they had been specifically instructed not to do."

A LETTER TO BARONESS CUMBERLEGE

Jean Robinson wrote to Baroness Cumberlege pointing out that:

"Ms French was not a patient of the obstetricians, yet they were dictating what
treatment should be available to a woman in normal labour under midwifery care.

...As for waterbirth being unevaluated, we all know that this applies to many
procedures used in maternity care. Moreover, obstetricians continue to use a number
of expensive procedures which have been well evaluated and found not to be
beneficial and even harmful....The policy seems to be that any form of care which
women want and midwives can give must be proven to be beneficial and harmless
before it can be adopted, but an entirely different rule applies to obstetricians.

...(The contract which the Trust has with the purchasers does not include the
provision of water births"). This has enormous implications. There may be many ways
in which skilled midwives assist or ease labour and delivery which mothers may
choose, which are not included in the contract, (e.g. eating during labour, adopting
different positions, use of aromatherapy, acupuncture or listening to Mozart). Are
these choices, made by women in labour, assisted by midwives who are
professionals in their own right to be excluded because they are not specifically
written into the contact?

...The Trust has no power to "permit" or refuse to permit how or where a woman
labours in her own home. If they are telling women that they only have the right to
labour in water if they get out when told they are putting out gross misinformation. If
they are making their midwives tell women this, then they are requiring midwives to
act in breach of the UKCC code, since they are deliberately giving women dishonest
information.

...The Supervisor of Midwives seems to be remarkably unaware of both her powers

and her duties. The Supervisor cannot "prohibit" a woman from giving birth in water,
she has no powers over the woman....If the Supervisor "prohibits" the midwives from
assisting at the delivery when the woman has exercised her right of choice to remain
in the water, she is asking them to act contrary to their professional code of conduct.
They could be removed from the midwifery register by the UKCC if they left the
woman, or failed to give her assistance at such a time. Any bullying or pressurising of
the woman to leave the water against her will would also be a likely breach of the
Code.
...In fact the Trust's contract with East and North Herts. Health Authority for maternity
care 1993/4 specifies: "10B -- All registered midwives will abide by the UKCC
Midwives' Code of Practice and the Midwives' Rules."

On the 4th March Jean Robinson and I travelled to Sawbridgeworth to meet Valerie
French, Garry Curran and local mothers to advise them on what action they could
take in this disgraceful case.

THE MIDWIVES APPEAL

The midwives appealed against the disciplinary action, and on 14th March 1994 their
appeal was heard, by Mrs Isherwood, vice-president of the Trust, Leslie White, Chair
of the Trust and Ann McPherson, Matron and Senior Nurse. The appeal lasted eight
hours and was dismissed.

The Royal College of Midwives is applying for a judicial review. Yvonne Hewins, who
represented the midwives, commented that "I have never come across such a
disgraceful hearing in 17 years' experience of handling affairs like this...The
miscarriage of justice continues in East Herts. What we have witnessed is not the
action of a fair-minded and reasonable employer." Local mothers, incensed by the
disgraceful treatment of these very respected local midwives presented a 1,400
strong petition of support to the Trust.

By now Dr Paul Lambden had changed his tune. This time, in a letter to the
NURSING TIMES, he claimed that the midwives "were disciplined, following
investigation of concerns reported by a third midwife, for breaches of behaviour and
personal conduct."

The actions of this Trust make a mockery of the government's policy document,
"Changing Childbirth", which is founded on the principle of giving women choice and
responding to their needs. Clearly East Hertfordshire NHS Trust has never read it,
and they are as well informed on this subject as they are on parents' rights and
waterbirth.

AIMS has submitted an official complaint about the conduct of Freda Kelly to the
UKCC, as you might expect. But that is not all. Valerie French has also submitted her
own independent complaint and in addition a group of local women have also made
an official complaint to the UKCC about Ms. Kelly stating that because of her actions
they no longer have confidence in her or in the hospital. We await the UKCC's
response to all these complaints with great interest.

Word count: 1585

Copyright Association for Improvement in the Maternity Services Jul 31, 1994

WATER LABOUR WATER BIRTH

Over the last few years women have increasingly chosen water for pain reli in labour
and for birth. Many women are attracted towater during labour, one women
commented that during her labour she spent hours in the toilet flushing th system just
so she could hear the rush of the water. Other women like to stand under a shower or
be near water, even though they may have no desire to get into it. No-one has
properly evaluated the potential pain relieving benefits of water and one hopes that
the international Water BirthConference at Wembley on the 1s and 2nd April will
stimulate research into this as well as research into birth in water.

Community midwives, for decades, have encouraged women to have a warm bath
during labour, but it was only when, in 1977, Dr Michel Odent, installed an inflatable
pool in his hospital in Pithiviers, France, that water birth became more widely known
to the public. Over a period of time, the women who were using the pool for pain relief
chose to stay in it and give birth there.

Dr Odent observed this development and started promoting it. In the UK Kei Brainin,
the husband of Janet Balaskas, designed a pool which could be plumbed into the
hospital systems. Slowly more and more hospitals took up the idea, and a number of
individuals set up their own pool hire businesses (we even have an AIMS group
which hires out its own pool - AIMS Edinburgh).

In some hospitals, a water birth is a real choice for women, but many hospitals have
only one pool and we often find a range of excuses to justify the low use of them. Like
the fashion in birthing chairs, which followed women's requests for squatting births,
many hospitals rushed to provide the facilities so that they could claim to be
responding to the users' wishes, but the staff we much more reluctant; unless you got
the one enthusiastic midwife your chances of getting a water birth were, and remain,
remote.

The Cornish are fortunate, they have a local GP, Dr Roger Lichy, who trave to a
home birth with the pool strapped to the roof of his car, but in the majori of areas
women have had to battle to get a water birth, and most GPs have not be interested,
some have been downright antagonistic.

In the early days, women went to amazing extremes to ensure they got what they
wanted. A woman in Hastings, hired a skip, put it in her garage, lined it with plastic
and gave birth in that! ..TX-While many midwives have been enthusiastic there have
been many doctors who have not. The general response from senior members of the
medical profession has been disappointing and, in the main, hysterical. The latest
outburst has been fr Frank Leoffler, an old school obstetrician who believes that "If we
become mesmerised by the eccentricities proposed by these aquatic fanatics, we
undermin social and technological advances and run the risk of turning the clock
back decades". He clearly needs to read Dr Marsden Wagner's book PURSUING
THE BIRTH MACHINE then he may begin to understand the damage the
technological advances ha caused and are still causing.

Unfortunately, for the medical profession, water birth is a new developmen which is
promoted by women and has, as far as we can tell, no known side effects It certainly
has far fewer side effects than pethidine or epidural anaesthesia. A woman in a pool
is very much more in control of her labour, and it is a great deal more difficult for the
staff to intervene. Therein lies the rub and, I suspect, the real reason for the medical
profession's hysteria. They have lost control, they didn't think of it and furthermore
birthing pools do not have any interesting knobs and flashing lights for the boys to
play with.

Last year, the Royal College of Obstetricians and Gynaecologists rushed to the press,
urging that as a baby had died following birth inwater this method of delivery should
stop until it had been properly evaluated. Whilst AIMS would vigorously support the
call for a proper evaluation of this new development we have some anxieties about
stopping this method of birthing until the end of a proper trial. Why not instead recruit
all the centres which have birthing pools into a trial and evaluate the outcomes? One
presumes that the RCOG's anxieties were provoked by the death of a baby, but if this
is a criteria for judging the quality of maternity care, why has the RCOG remained
totally silent about the sixteen babies that died having been exposed to Doppler
ultrasound in a randomis controlled trial at Queen Charlotte's Hospital, London?
These sixteen dead babie were four times as many as died in the unexposed group.
There has been total silence from the RCOG. Could it be that as ultrasound is
medically approved and vigorously promoted such deaths are not so worrying to
them?

In January, last year, two community midwives attended a woman at home who
wanted a water birth. They were told by their Supervisor of Midwives that they had to
instruct the woman to get out of the water for the birth. This they did, but the woman
replied that she appreciated their advice but intended to stay where she was. The
midwives, confident that they had carried out the Supervisor' instructions, went ahead
and delivered the baby. The following day the Superviso suspended the midwives
and disciplined them. The lead midwife is now working for another health authority.
The Supervisor of Midwives is, herself, now the subjec of a complaint to the UKCC.
The word soon spread amongst the midwives that they could be suspended if they
"allowed" a woman to give birth in water, and AIMS was receiving calls from all over
the country from women saying that they had been told that they could not have
a water birthbecause their midwives had not been properly trained.

In order to clarify the position of midwives who were being asked to assis a water
birth I asked the UKCC's midwifery committee to consider producing a statement. On
the 6th October 1994 the UKCC issued a Position Statement on Waterbirths which
clarifies the role and responsibilities of attending midwives and Supervisors of
Midwives.

The following are some of the relevant sections which point out that the midwife has a
duty to attend the woman; and the Supervisor of Midwives is requir to provide
adequate support:

5. The Council recognises that waterbirth is preferred by some women as their

chosen method of delivery of their babies. Waterbirth should, therefore, be viewed as
an alternative method of care and management in labour and as one which must,
therefore, fall within the duty of care and normal sphere of the practice of a midwife.
Waterbirth is not considered to be a "treatment".

7.1 "A practising midwife is responsible for providing care to the mother and baby
during the antenatal, intranatal and postnatal periods". A midwife shou not, therefore,
refuse to continue to provide care for a mother.

7.2 The midwife should discuss the matter with her supervisor of midwives in order to
seek further professional advice about the most appropriate action in the
circumstances. If alternative arrangements are impossible to make, the midwife
should not withdraw care and, thereby, leave the mother unassisted for delivery.

7.3. If the mother rejects the midwife's advice,....The midwife must continue to give
unbiased care to the best of her ability, seeking peer support as necessary.

7.5. It is the duty of the supervisor of midwives, being mindful of the woman's right to
choose, to ensure that agreed local policies are formulated wit the advice of
practising midwives and supervisors of midwives.....The local poli should ensure that
the midwife has the required support in all settings.

Word count: 1317

Copyright Association for Improvement in the Maternity Services Apr 30, 1995

"There is no demand for a water birth"

Beverley Beech reports on a visit to Wexham Park and Heatherwood hospitals.

Not long ago I visited both Wexham Park Hospital and Heatherwood Hospital and
discovered that while the midwives at Heatherwood were very interested in
using water for pain relief they had been banned from "allowing" a woman to birth in
the water because of the local consultants' veto.

While visiting Wexham Park Hospital a midwife commented that there was "no
demand for water birth". As there are no posters advertising Wexham Park's pool
room, no leaflets drawing attention to this facility, and not even a notice on the pool
room door, I wondered how women would know it was available anyway. So, I
decided to do a quick survey.

I spent three hours in Slough's main shopping centre and approached any women
with a baby who appeared to be under the age of 2 years. Altogether 20 women
agreed to answer questions. Of these 12 lived in Slough and the remainder lived in
the local villages but three travelled from Maidenhead and Hounslow. Seventeen
women gave birth in Wexham, two in Heatherwood and one at home. As the rate of
home birth in this area is less than 1% it was astonishing that my first interview was
with a woman who had a home birth! Eleven women had given birth in 1999; five in
1998, three in 1997 and one was pregnant (20 weeks and pushing a pram containing
her friend's baby). Ten women were expecting their first baby; 4 their second; 4 their
third and one was expecting her fifth.

I asked them if they had considered giving birth anywhere else; 16 said no. Their
reasons were: "Wexham was the only option"; "no choice", "I wanted to go to
Heatherwood but could not as I was considered high risk"; "Heatherwood was the
nearest hospital"; "I had no information about any alternatives and my blood pressure
went up so I had to go to Wexham".

Of the 4 who said they did consider birthing elsewhere one wanted a home birth, but
was told that she could not as it was her first; one was considering Heatherwood but
was impressed with Wexham and went there; two had booked caesareans, one
because she'd had previous caesarean for a baby that was "too big" (eight and a half
pounds); and one booked, and got, a home birth (she was an NCT tutor, which may
explain why she was successful).

The women were asked about the type of birth they had: 13 claimed to have had
normal births. These included one ventouse, one forceps, two had booked
caesareans, one emergency caesarean. One woman stated that she did not have a
normal birth but a vaginal delivery following an epidural; and the pregnant woman
expressed a wish for a normal birth.

Of the 14 women who claimed to have had a normal births, 5 had

their waters broken, 9 had electronic fetal monitoring, 4 had a drip to accelerate their
labours, 8 had epidurals and 1 had an episiotomy. Only 4 of these 14 women would
have fulfilled the AIMS criteria for a normal physiological birth.

For pain relief (apart from the 14 epidurals) the women used pethidine (3); gas and
air (5); TENS (2) and 4 women had no pharmacological pain relief at all. They were
asked if they were interested in using water for pain relief. Ten said no and gave a
variety of reasons: "No-one mentioned it"; "in the dark about it" (no information); "not
offered"; "baby's heart rate dropped" (given an epidural) and one said she was "not
interested".

Nine women said they were interested in using water for pain relief. One woman said
that "the water was quite cold" (when shown the pool antenatally) so she decided
against it; others said there was "no choice at Wexham"; "it was not offered" and "the
staff were too busy anyway"; "did not ask during the labour and the staff did not offer
it"; one woman was told that as the first birth was "difficult" she was strongly advised
against using the pool (she birthed using only gas and air); one was told that she
"had to get out of the pool for the birth" so she decided that, in that case, she would
not get into the water, and one had two previous caesareans and had been booked
for a third.

The women were asked if they had considered giving birth in water. Nine said "yes"
but four were told that they do not "allow" birth inwater; one wanted to do so but it
was not offered; one had written it in her birth plan, which was then ignored.

Twelve women said they knew there was a pool at Wexham but seven did not, and
one thought it was "only for private patients". Fourteen did not know there was a pool
at Heatherwood but six did.

If all the women had known about the Heatherwood pool would some of them have
chosen to birth there? Twelve women said that they knew about the Wexham pool
(two had been shown the pool on a tour of the hospitals) but only six knew there was
a pool at Heatherwood (the two women who birthed at Heatherwood knew about
their pool). Seven women did not know that there was a pool at either Wexham or
Heatherwood.

This small informal survey shows that what women are told, and what they are
offered, has an affect on their decisions. The fact that women are told that they "have
to get out of the pool for the birth" may put many more women off even getting in.
Women are entitled to make real choices about their care and be given full and
accurate information, otherwise claims of there being "no demand" are nothing more
than a sham.

Word count: 981

Copyright Association for Improvement in the Maternity Services Jan 31, 2000

Who says birthing can't be painless, relaxing and soothing; of course, it can
be! Water birthing is a very natural birthing process in a quite soothing, and relaxing
atmosphere. It is gentle birthing because the immediate pain reduction felt upon
entering the warm waterpool meant for natural birth is quite noticeable. By increasing
relaxation, water also helps lessen the chances of tense breathing. As you relax
in water, pain relieving chemicals are released. Let us understand why water birthing
is good for you.

Water birthing is a new approach to the process of childbirth. During the natural
birthing process the mother stays calmer and becomes less stressed. She sits in an
inflatable, soft comfortable pool of warm water in presence of a team to support her
delivery. The soothing ambience and spa like labor room with dim lights provide
painless & relaxing birthing experience. During labor as the mother sits in the water; it
gives freedom of movement to the mother and relaxes her immensely. As she
relaxes, she can take different positions at ease as water immersion helps ease pain
and control movement. The effect of buoyancy that the deep-water immersion creates
allows the spontaneous movement of the mother. No one needs to help her to get
into a new position. She moves as her body and baby dictate. The natural warmth of
the water helps calm the nerves and significantly reduces pain and makes her feel
relaxed without pain relieving drugs and medical intervention during labour. When
mother is relaxed her labor progresses fast and she has a short labor.

For those who prefer soothing, relaxing, gentle birthing experience, water birth is
worth considering. There is a calmness with which a mother brings her baby into the
world as well as the ease of transition for the newborn. When the baby is born, it is
brought to the surface in the presence of expert doctors and attendants.

As soon as the newborn senses a change in the environment from the water into the
air, a complex chain of chemical, hormonal and physical responses initiate the baby's
first breath. Usually this is a quiet transition from labor to birth. Babies have a calm
serene look after they emerge from the warm bath unto the mother's chest and feel
their mothers' warmth.
Advantages of water birth:

- Water Immersion Releases Endorphins: A complex chain of chemical, hormonal

and physical responses release endorphins - the pain relieving hormones.

- Water Birth Reduces the Risk of Tearing: Water immersion relaxes muscles and
tissues. particularly of the perineum.

- Water Birth is Peaceful: The tranquil atmosphere around the pool with dim lights all
around along with the warmth of water make the labor painless and the mother feel at
ease.

Water birth is not good for everyone. Water birthing is advisable for healthy woman
with uncomplicated pregnancies. Water birth can only be possible if the woman in
labour gets the services of an experienced midwife or gynaecologist. In
general, water birth is not recommended for women with chronic health conditions
like heart disease, kidney disease and diabetes, high blood pressure and herpes
infection or any other major urinary tract infection. Water birth cannot be
recommended if the mother has twins or the baby is breech (feet or bottom first).
During water birth the mother can't be left unattended. The mother must receive one-
to-one care.

If a woman meets the healthy and low-risk criteria, she can have water birth in a
hospital with experts gynaecologist, doulas, nursing staff and midwives.
Therefore, water birth can't be possible everywhere and even at the healthcare
centres that go on easy with waterbirthing even without proper facilities and experts.
If your chosen hospital or birth centre does not offer better facilities for water birth,
don't prefer it. In a nutshell, Water birthing demands specialists, trained doctors, and
nurses.

Dr. Sarada M

DGO, MRCOG, DNB

Consultant Obstetrician & Gynaecologist

Continental Women's Center

Continental Hospitals

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Copyright Kasturi and Sons Ltd Aug 18, 201
WATER BIRTH STUDY DAY

MIDIRS (Midwives Information and Resource Service)

Dundee, June 1993.

Dr. James Walker, an obstetrician from Glasgow, put forward the view held by most
obstetricians and paediatricians, that water is not a natural environment for birth, that
there is no evidence to show that it is gentle or safe, that there are no particular
benefits to givingbirth in water, but that it appears to be beneficial in reducing pain in
the first stage of labour.

Joan Milne, Midwife Manager from Aberdeen, was a pleasure to listen to. Her
message to midwives is to meet the challenge water birth offers through up-to-date
information, skill sharing, discussion, good documentation and appropriate
guidelines. She listed numerous practical suggestions for minimising risks to mother
and baby and for ensuring a positive experience for both mothers and midwives,
emphasising that attending water births is well within the sphere of the midwife's
competence.

Irene Johnson, Senior Midwife from Glasgow gave an interesting overview of how the
introduction of a birth pool to a unit could be approached. She looked at the sorts of
questions that should be asked around the installation of a pool and how to determine
appropriate use of the pool.

Janet Balaskas, Director of the Active Birth Centre in London and author of the book
`Waterbirth', gave details about the positive feedback women give following the use of
pools for labour and/or birth. A pool she claimed is far superior to a bath or shower as
it affords greater freedom of movement. Water has many positive properties including
its propensity to heal. She questioned the so-called unnaturalness of birth in water by
quoting new theories, linking us more closely to aquatic primates. In one hospital in
London, the third stage of labour may take place in the pool - there have been no
reported problems with this practice.

All four speakers gave their own recommendations on criteria for safe use of pools.
Whilst they varied, all accepted in principle the idea of a healthy mother carrying a
term baby as being a good starting point.

Caroline Weddell and Fiona Mackenzie both had their first babies in birth pools and
each gave an account of the experience. Both strongly confirmed the very positive
feedback one hears time after time following the use of a pool.
The day generated some debate, but there seemed to be an air of caution and
unease. Waterbirth is relatively new in most parts of Scotland and will no doubt take
time to become established practice. Midwives also face lack of support from their
medical colleagues and, whilst many are enthusiastic, feel vulnerable because of this.

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Copyright Association for Improvement in the Maternity Services Jan 31, 1994

VICTORY FOR WATER BIRTH

In 1990, friends of one of the large health centres in Southampton decided to raise
funds for a water tub to be used during homebirths and, they hoped, at the large
consultant unit, the Princess Anne Hospital.

The tub was purchased in November 1990, and its availability publicised widely. The
next hurdle was to get the tub used and accepted at the Princess Anne. A woman
having a GP delivery (the hospital has a GP unit) booked to use the tub. The tub was
to be accepted in the hospital and fun was about to begin.

The first outing was in March 1991. The planned birth was to be in water. All the
hospital authorities knew this and it was to be supervised by two community
midwives. Everyone was really excited. Several people concerned with the tub
generated a lot of publicity about this coming event.

The day after the birth, the headline across the front page of the SOUTHERN
EVENING ECHO was:

"BANNED: No more underwater births, says hospital."

Apparently the birth embarrassed the authority because it broke hospital policy. The
parents of the water baby were outraged at the hospital decision to stop other women
following their example.

The midwifery manager told the newspaper that women could use the birthing pool
for pain relief during labour, but the hospital cannot allow them to deliver underwater.
The hospital claimed that the baby was delivered in the pool only because the mother
could not get out in time for the second stage of labour. The mother claimed this was
untrue. Her GP, who was present at the birth, confirmed thewater birth had been
planned for months.

The ECHO continued with the story. It contacted me, as chair of the local NCT
branch, and asked for my opinion. I replied that the NCT believes in choice for
women, and if a woman feels the need to use a pool to labour and give birth in, then
we would support her decision.

The ECHO organised a telephone poll - should mums have the right to
give birth in water?(1) The result was an overwhelming success for water birth. 81%
of voters said they believed mums should be allowed the choice of
giving birth in water. As a result of this, the hospital management said they were now
looking into the safety aspects of underwater births and that the method would not
necessarily be ruled out in the long-term.

Since then the pool has been used at the GP Unit for 13 deliveries, most of
them water births. The community midwife who has supervised all deliveries so far is
`snowed under' with requests from women who want to use the tub, and she is trying
to ensure that a different community midwife assists with each delivery. As the tub is
restricted to community use only (it was originally bought by the health centre for GP
unit and home use) women who want to use it have to be booked into the GP Unit
and so hopefully there should be a rise in use. In fact interest in the use of the pool
has been so great that the consultant unit is looking into purchasing a tub for its own
use. However, due to the hospital protocol drawn up for water tub use, it will be for
labouring in only. The protocol is the way it is mainly because the paediatricians are
worried about women giving birth in water. However, they are willing to revise this at
any time.

The water tub situation now looks positive, and we are very lucky to have midwives
who are keen to use it and a hospital that is beginning to realise that you do not have
to lie on your back to give birth.

AIMS Southampton would like to thank Beverley Beech for her expertise and help in
this matter.

Southampton AIMS would also like to pay tribute to the SOUTHERN EVENING
ECHO whose interest and support for pregnant women during this campaign was
fantastic. They helped the cause of choice in childbirth for everyone, and put our
AIMS group on the map.

REFERENCES

(1) SOUTHERN EVENING ECHO, 14-15 March 1991

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Copyright Association for Improvement in the Maternity Services Oct 31, 1992